title: Spinal cord stimulation and intrathecal baclofen therapy: combined neuromodulation for treatment of advanced complex regional pain syndrome.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) is one of the widely used procedures for the treatment of complex regional pain syndrome (CRPS). However, complete pain relief is rarely achieved, and the SCS effect diminishes over time. Recently intrathecal baclofen (ITB) therapy is reported to be a modality for treating fixed dystonia related to CRPS. Other reports have suggested that ITB therapy can enhance the effect of SCS in patients with neuropathic pain. We report the effectiveness of combined SCS and ITB therapy, focusing on the role of ITB therapy as an adjunctive therapy for controlling symptoms of advanced CRPS.
  
  
  METHODS
  Five affected extremities of 4 patients with CRPS (2 male; mean age, 32.5 years) refractory to conservative treatment were evaluated retrospectively. Three patients underwent SCS implantation first, with ITB pumps being implanted a few years later. Bolus ITB injection was administered under temporary percutaneous SCS in 1 patient. Pain intensity was evaluated using the visual analogue scale (VAS) before and after ITB administration.
  
  
  RESULTS
  Pain relief of more than 50% was observed in the upper extremity of 1 patient and one of more than 30% was observed in 2 patients. The mean pain reduction rate in all 4 patients was 28.9% before and 43.8% after treatment. All patients, including those without any improvements in VAS score, showed decreased postural abnormalities after combined SCS and ITB therapy. Improvement in postural abnormalities, such as fixed dystonia or paroxysmal tremor-like movements, resulted in overall pain relief by reducing pain fluctuations.
  
  
  CONCLUSIONS
  Combined SCS and ITB neuromodulation decreases pain intensity in refractory CRPS cases or improves associated abnormal dystonic posture and movement disorders and reduces pain fluctuations.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Goto
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.forename: Shiro
authors.initials: S
authors.lastname: Horisawa
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Yokote
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sasaki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000328:Adult; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D020918:Complex Regional Pain Syndromes / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D059408:Pain Management; D010147:Pain Measurement; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen